title: A dominant adenocarcinoma with multifocal ground glass lesions does not behave as advanced disease.
abstract: BACKGROUND
  Invasive lung adenocarcinomas increasingly present with synchronous, multifocal, in situ lesions that appear as ground glass opacities (GGOs). The optimal approach in this circumstance (often nonsmokers) remains unclear. We evaluated a general strategy of anatomic resection of the dominant tumor (DT) and wedge resection of accessible ipsilateral GGOs.
  
  
  METHODS
  This is a retrospective review of 39 patients with suspected multifocal in situ adenocarcinomas and 1 DT in a predominantly Caucasian population. Mean follow-up is 30.7 months.
  
  
  RESULTS
  Forty-nine percent of patients had no or minimal smoking history; 21% were Asian. The resected DT was pathologically "bronchioloalveolar carcinoma" (26%), minimally invasive adenocarcinoma (5%), adenocarcinoma with bronchioloalveolar features (41%), or moderate well-differentiated adenocarcinoma (28%). The p stage of the DT was IA in 20, IB in 15, and IIA in 4, with mean diameter of 2.6 cm. Thirty-two patients (82%) underwent anatomic resection of the DT; 7 (18%) underwent wedge resection. The mean number of GGOs present initially was 2.7 (range, 1 to 7) with a 5.2-mm mean diameter. An unresected nodule increased in size during follow-up in only 9 patients (23%). The mean diameter growth among these was 3.2 mm, with mean doubling time of 49 months. New GGOs (range, 1 to 8) developed in 16 patients (41%), all of which remained at 7 mm or less. Distant metastasis developed in 2 patients (5.2%); only 1 patient has required intervention for progression of a GGO. The overall survival is 100%.
  
  
  CONCLUSIONS
  Patients with limited, multifocal, in situ adenocarcinomas and a clinical N0 DT enjoy prolonged survival with generally anatomic resection of the DT and wedge resection of accessible GGOs. These patients should not be considered to harbor T4 or M1a disease.
authors.affiliation: Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Bo
authors.initials: B
authors.lastname: Gu
authors.forename: Bryan M
authors.initials: BM
authors.lastname: Burt
authors.forename: Robert E
authors.initials: RE
authors.lastname: Merritt
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stephanie
authors.forename: Viswam
authors.initials: V
authors.lastname: Nair
authors.forename: Chuong D
authors.initials: CD
authors.lastname: Hoang
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Shrager
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology* / Q000601:surgery*; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods; D012189:Retrospective Studies
keywords: 10; AAH; AC; AIS; AJCC; American Joint Commission on Cancer; BAC; COPD; CT; DT; GGO; LPA; MIA; NSCLC; SBRT; SCC; SD; VATS; adenocarcinoma; adenocarcinoma in situ; atypical adenomatous hyperplasia; bronchioloalveolar carcinoma; chronic obstructive pulmonary disease; computed tomography; dominant tumor; ground glass opacity; lepidic predominant adenocarcinoma; minimally invasive adenocarcinoma; non-small cell lung carcinoma; squamous cell carcinoma; standard deviation; stereotactic body radiotherapy; video-assisted thoracoscopic surgery